Introduction Acute coronary syndrome (ACS) is an umbrella term for a wide spectrum of clinical sign and symptoms suggestive of myocardial ischaemia. The ultimate clinical implication of ACS may therefore vary from assuredly benign to potentially fatal. Thus further risk stratification of this syndrome complex is imperative. It has been seen that 50 per cent of patients hospitalized for suspected ACS ultimately leave the hospital with other diagnoses (1). Further management of ACS is resource-intensive and thus proper risk stratification is mandatory to avoid needless hospitalizations and interventional procedures. The traditional clinical tools for risk stratification such as history, physical examination, and ECG though undoubtedly important may prove to be inadequate in the majority of cases. This has led to the search for circulating markers that better establish diagnosis and thus aid in appropriate and rapid patient triage. The cardiac necrosis markers creatine phosphokinase and its isoenzymes and especially troponin have come to the forefront in the past decade to better identify high-risk individuals suitable for the most resource-intensive treatment. This is reflected in the various management guidelines of ACS where cardiac enzymes are the cornerstone in decision making. In addition, the success and usefulness of these biomarkers has led to intense research in this field resulting in several newer biomarkers emerging on the horizon of clinical use in ACS.